Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry

This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.

[Scrotal leiomyoma]

A case of a 32-year-old patient with a diagnosis of leiomyoma of the scrotum was studied. Histologic analyses did not yield evidence of malignancy. Full excision of tumor was achieved and the postoperative period was uneventful.

A pilot study of recombinant interleukin-2 for treatment of chronic hepatitis C

The optimal and safer interleukin-2 (IL-2) dose for treatment of chronic hepatitis C virus (HCV) infection has been studied in 33 HCV-RNA positive patients with chronic hepatitis C. Patients were randomly allocated to receive 5 days per week during 12 weeks IL-2 doses of: 0.9 MIU (n = 10), 1.8 MIU (n = 10), or 3.6 MIU (n = 13). After 12 weeks, responder patients stopped treatment, whereas nonresponders received 12 additional weeks of IL-2 at the next higher dose: 1.8, 3.6, or 5.4 MIU. As a whole, after the first 12 weeks of IL-2 alanine aminotransferase (ALT) levels significantly decreased (P < .001) with respect to the baseline values (140 +/- 63 vs. 70 +/- 30 IU/L). At the end of treatment (24 weeks), the mean ALT level (80 +/- 50 IU/L) continued significantly lower (P < .001) than the baseline one, and 24% of patients normalized ALT levels; according to dosage, ALT normalization was: 0% for 0.9 MIU, 25% for 1.8 MIU, 5% for 3.6 MIU, and 18% for 5.4 MIU. HCV-RNA levels decreased during treatment, but in none of the patients became undetectable. All patients had a local reaction at the injection site with induration, erythema, and swelling, which was dose-related. The dose of 5.4 MIU was poorly tolerated and was reduced to 3.6 MIU in 4 of 11 patients. No changes in hematological parameters were observed. At the end of follow-up (6 months) four of eight responder patients continued with normal ALT. In conclusion, IL-2 treatment for chronic hepatitis C induced a biochemical response in 8 of 33 (24%) patients at the end of therapy while at the end of follow-up, 4 of 33 (8%) patients remained with normal ALT. The dose of 1.8 MIU is well tolerated and seems to be the most efficacious.

[T-cell-rich B-cell lymphoma: multifactorial study of 4 cases]

PURPOSE

With the correlational study of four cases in several areas (clinic, morphoimmunologycal, ultrastructural and genetic) we try to valorate the still controversial entity known as T-cell rich B-cell lymphoma (TRBL), and stablish some useful clues in order to settle down the differential diagnosis between TRBL, Hodgkin's disease (HD), and T-cell non-Hodgkin's lymphomas (TNHL).

PATIENTS AND METHODS

Cases proceeded from Oncology Department, and had been firstly misdiagnosed either as HD (3 cases) or as TNHL (1 case). Biopsies were processed and stained in routine way, H&E, Giemsa and Wilder. Immunohystological study, using monoclonal antibodies against B-cells, T-cells, histiocytes, activation and proliferation markers, was also performed with avidin biotine peroxidase (ABC) method. Ultrastructural study was performed in three of the cases; two patients were studied by PCR and Southern blot.

RESULTS

All of the cases showed a diffuse hystological pattern, with variable fibrosis, and proliferation of venules and capillaries. Small lymphoid cells, being positive for CD3, were dominant. Large blastic cells, positive for CD20, some of them with a Sternberg-like appearance, could be found, in a spitty pattern. Histiocytes were abundant and positive to CD68. Proliferation index (Ki-67) ranged between 13 and 24.5% being the stain mainly positive for B-cells and in a certain extent, also for T-cells. Ultrastructural features were closer to those of the NHL than to the ones found in HD. Molecular study failed to prove any rearrangement.

CONCLUSIONS

TRBL is a rare entity between B-cell NHL group. Diagnosis and differential diagnosis (mostly with HD and T-cell NHL) have to be properly made, because of the very distinct prognosis and therapy.